GRANTMAKERS FORUM OF NEW YORK - COMMON APPLICATION FORM INFORMATION FOR GRANTSEEKERS

GRANTMAKERS FORUM OF NEW YORK - COMMON APPLICATION FORM INFORMATION FOR GRANTSEEKERS NOTE: Before using the Common Application Form (CAF) to apply for a grant, determine if the funder to whom you are applying accepts the form (consult list below or call the grantmaker directly). Applicants are advised to consult the Grantmakers section of the current Guide to Grantmakers in the Rochester Area (Guide) or another grantmaker listing to see if their project or program matches the funder s interest. Follow procedures for each funder as described below. The CAF can be downloaded in MS Word format at no charge from the Grantmakers Forum of New York website, www.grantmakers.org. A diskette with the CAF can be purchased from the Grantmakers Forum of New York for $8. (Mail a check payable to the Grantmakers Forum of New York to 919 Winton Road South, Rochester, NY 14618-1633.) The funders listed below have agreed to accept the Common Application Form with the following requirements. Unless otherwise noted, funders require all sections of the CAF to be completed. If a dollar amount is listed with the funder s name, applicants requesting less than the stated amount may use the Common Application Short Form (omits items 3 and 4, the logic model and rationale). Additional Instruction Notes: (a) Funder requires additional information contact funder or consult the Guide to Grantmakers in the Rochester Area. (b) Requires letter of inquiry before applying. (c) Call before applying. Examples: ABC Foundation, $5,000, (c): Use Short Form for requests below $5,000. Call before applying XYZ Corporation, $1,000, (a, b): Use Short Form for requests below $1,000. Send letter of inquiry before applying. Application requires additional information beyond the CAF The Smith Trust (b): Requires full CAF for all proposals. Send letter of inquiry before applying. The Common Application Form (CAF) was developed in 1999 by the Rochester Grantmakers Forum (RGF) and the Rochester Effectiveness Partnership (a funder/nonprofit collaborative to increase effectiveness) to facilitate the application process for both grantmakers and grantseekers, and to focus on results. Grantmakers and grantseekers worked together to create it. ORGANIZATIONS THAT WILL ACCEPT THE COMMON APPLICATION FORM Advertising Council of Rochester (a, c; use Short Form for consultant, full CAF for community impact requests) ALSTOM Signaling Foundation, $5,000 American Wildlife Research Foundation Ames-Amzalak Memorial Trust, $1000 Bausch and Lomb, $5,000 Birdseye Foods Foundation (use ShortForm for all requests) Bulrush Foundation Caldwell Manufacturing Company, $5,000 Citibank, $10,000 Cornyn Foundation, $1,000 Charles & Mary Crossed Foundation Davenport-Hatch Foundation Delphi Automotive Systems, $1,000 Eastman Kodak Company, $10,000 (a) Everett Charitable Trust, $10,000 Foundation for the Jewish Community, $10,000 Foundation of the Monroe County Bar, $5,000 Goldberg Berbeco Foundation (a; use short form for projects with total budget under $10,000, full form for all others) Golisano Foundation, $2,500 (a) Halcyon Hill Foundation, $5,000 (b) HealthNow NY, (use short form for event underwriting under $1,000, full form for all other requests) Daisy Marquis Jones Foundation, $6,000 (b) KeyBank of New York, $10,000 Suzanne Lee Charitable Trust Oliver B. Merlyn Foundation Mary S. Mulligan Charitable Trust, $5,000 RCIPA Community Health and Educ. Fdn., $1,000 Rochester Area Community Foundation Rochester Female Charitable Society Rochester Primary Care Network (for pre-selected applicants only) Dorothea Haus Ross Foundation Kilian J. & Caroline F. Schmitt Foundation (short form) Wegmans Food Markets, $1,000 Fred & Floy Willmott Foundation, $2,500 (proposal should be 1-sided and not bound or stapled) M.C. and J.C. Wilson Foundation, $25,000 (c) Unity Health Foundation, $1000 (b) Women s Foundation of the Genesee Valley Wyman-Potter Foundation (use short form for all requests; additional information may be requested) Xerox Corporation, $2,500 1 Revised GFNY Common Application Form, effective November 2006

APPLICATION CONTENT NOTE: Applications should be legible. Handwritten in black ink, word processed or typed. Organization = nonprofit whose 501(c)(3) status is being used. A complete application will include items 1-10. Some funders will accept the Common Application Short Form omitting items 3 and 4. Please refer to the Information for Grantseekers cover sheet for additional information. 1. Executive Summary (This will take the place of a cover letter.) Please create in bulleted rather than narrative form. To save you time, we suggest that you wait until after completing the rest of the proposal to develop this section. We encourage you to limit this to one page or less. It should be a brief synopsis of your request, able to serve as a standalone piece. A. Organization name B. 1. Project/activity name 2. One sentence summary of project/activity C. For this request, summarize: 1. Why (community need) 2. Who and how many (target population, including age, gender, ethnicity, other relevant characteristics) 3. What (services provided) 4. When (timeframe) 5. Where (location of the work) D. What do you hope to accomplish (outcomes)? E. How does this request meet this funder s priorities? F. State the total cost of this effort, and the amount requested from this funder. G. Signatures of CEO and a board representative, preferably the board chair or president. 2. Information sheet (use attached form). 3. Logic model (use attached form and instructions). 4. Rationale (follow attached instructions). 5. Program or Project Budget sheet (use attached form). 6. Financial summary of your organization s most recently completed fiscal year, including the original budget and actual revenue and expenses for that year. 7. If you are a 501(c)(3) organization, a copy of the IRS determination letter advising that your organization is exempt from taxes under Section 501(c)(3) of the IRS code, and that the organization is not a private foundation as defined in Section 509(a). 8. Listing of organization s Board of Directors with their affiliations. 9. Most recent audited financial statement and accompanying management letter for a complete fiscal year of the organization. If your financial statements have never been audited, indicate why e.g. you are too small, or your organization is too new. 10. Annual report, if available, or a brief description of the scope of your organization s work. 2 Revised GFNY Common Application Form, effective November 2006

2. INFORMATION SHEET GRANT APPLICATION TO (name of funder): Organization Information Name & address of applicant organization: Telephone Number: Fax Number: E-mail: Chief Executive Name and Title: 9-digit Federal Employer ID #: Year organization incorporated: Is the name at the left the same as it appears on the IRS 501(c)(3) Letter of Determination? Yes no If not, explain: For current fiscal year: Organization s total budgeted revenue: Organization s total budgeted expenses: Fiscal year: to Revenue Sources: % government (city, county, state, federal) % United Way % membership % fees % grants % investment income % fund raising (e.g. events, gifts, bequests, etc.) Information for This Request Name of this program or project: Program/project contact person: Name: List other potential and actual sources of support - place * by those committed, noting any matching fund requirements. Amount: Funder: Phone #: Total cost of this effort: Amount requested from this funder: Type: Capital Construction Renovation Equipment Endowment Program/Project General Support Other (describe) List major funders of program/project for past two years if applicable: Amount: Funder: Date funds needed by: Date by which funds will be spent: 3 Revised GFNY Common Application Form, effective November 2006

Guidelines for Completing the Rochester Area Logic Model A logic model is a valuable organizational planning, implementation, funding and quality improvement process tool. It describes how programs or capital projects are expected to work in achieving desired outcomes, while identifying the need for adjustments and improvements. The Rochester Area Logic Model was developed by a representative group of health and human service providers and private and public funders to create a common format. This outline is intended to guide you in using the Rochester Area Logic Model. For additional information about the Logic Model, consult the Grantmakers Forum of New York Common Application and Report Forms. The five areas included in the model are outlined below in the order they should be considered when planning a program or capital project; the actual model is organized differently (see enclosed format). Here are the five areas: Writing Your Logic Model The goal should be a one-sentence overview of what the program or capital project is designed to accomplish and for whom. 2. Projected outcomes are benefits or changes directly affecting individuals or populations during or after participating in activities. They show effects on knowledge, attitudes, skills, behavior, condition or status. Examples include increased reading levels, improved parental management skills and increasing home ownership. The following are not outcomes: number of participants served, participant satisfaction, reports completed. Time frames for short-term versus long-term outcomes will vary based on the type of program or activities. Short-term outcomes should occur within a time frame that allows you to measure them. You may be able to measure some long-term outcomes as well; others may go beyond the scope or time frame that you can measure, but are expected to occur and may be related to short-term outcomes (when completing the model, note with an asterisk (*) outcomes you plan on measuring). 3. Activities show what you do with the inputs/resources to achieve your outcomes. Examples include support groups, job clubs, individual counseling, structured recreation programs, surveys, etc. Activities should be quantified to show information such as frequency, duration and participation. 4. Inputs are the resources needed to carry out your activities and accomplish your outcomes. Staff, funds, volunteers, materials are all examples of inputs. Inputs should be quantified whenever possible (e.g. number of full-time equivalent (FTE) social workers). 1. Relationships between inputs, activities, short- and long-term outcomes are sometimes shown by drawing lines to show the relationships. This can result in a completed logic model that is difficult to read, and is not recommended. Often inputs have an effect on multiple activities and outcomes and cannot be directly related to each item on your logic model. When reviewing the logic model, make sure that all inputs and activities can be logically related to outcomes. Refer to the sample models to see examples for each area discussed above. 4 Revised GFNY Common Application Form, effective November 2006

3. ROCHESTER AREA LOGIC MODEL (See attached Logic Model Section for guidelines and sample logic models.) Program/Project Agency Date Program/Project Time frame: Program/Project Goal: Names & titles of those with key roles in developing logic model: Inputs ($ s, staff, volunteers, materials & other resources required) Quantify inputs wherever possible (e.g. 2.5 FTE social workers, 270 volunteer hours ) Activities (What the program does with the inputs to achieve its outcomes) Activities should be quantified (e.g. 2 support groups/10 moms ea./2 hrs/wk for 4 mos.) Projected Outcomes (Effects on knowledge, attitudes, skills, behavior, condition or status during or after the program/project) Shorter-term Outcomes Longer-term Outcomes Place a * next to those to be measured Place a * next to those to be measured (Add additional pages if needed.) 5 Revised GFNY Common Application Form, effective November 2006

4. RATIONALE (Please include the following. We strongly encourage you to limit the total length of the rationale to 4 pages or less.) A. Need/demand (present in bulleted format, and where possible, include local statistics, community priorities, etc) 1. Summarize the need for your planned work. 2. Summarize customer demand for this work. B. Outcomes For each outcome you will track, as identified in your logic model, indicate how you will know if you succeed in achieving it, using the following format. Outcomes Indicators/Measures (What will you measure to know if you reach your outcomes?) Targets/Performance Standards/Projected levels of success/what will tell you that you have achieved your outcomes? By when will targets be achieved? C. Activities (use bullets or a chart where possible) Why do you believe the activities listed in your logic model reduce or eliminate the need described in item A on this page? D. Organizational capacity to undertake project 1. What is your organization s mission, and how does this project relate to it? 2. Summarize similar program accomplishments in the past, including the extent to which your outcomes were reached (use bullets or a chart where possible). E. Links with other agencies 1. If this is a collaborative effort, complete the following: Collaborating organizations Contact person Phone number Role(s) of partners 2. Do you know of other groups doing similar or related work? If so, how does your work differ from or complement theirs? F. What is the future of this program or project beyond the grant period? 1. In terms of programming, summarize what is envisioned. 2. If it is to continue beyond the grant period, how will you support this project? G. In no more than ½ page, say anything else you want to about this request. 7 Revised GFNY Common Application Form, effective November 2006

5. PROGRAM OR PROJECT BUDGET SHEET A. Provide the following information regarding the program or project for which you seek funds. SUPPORT/REVENUE 1. Requested grant 2. Fundraising events 3. Gifts/bequests 4. Miscellaneous contributions 5. Foundation/corporate grant support 6. United Way 7. Grants/contracts: govt. agencies 8. Program service fees 9. Membership dues 10. Investment income/transactions 11. Sales: services, products, crafts 12. Miscellaneous revenue 13. Subtotal Direct Support/Revenue 14. Proration: General & Management Income 15. Total Support/Revenue Total Anticipated Support/Revenue EXPENSES 16. Salaries of provider staff 17. Fringe benefits 18. Professional fees (contract, consultant) 19. Supplies (consumable) 20. Printing and postage 21. Occupancy 22. Phone and fax 23. Travel and meetings 24. Training 25. Evaluation 26. Equipment purchases 27. Miscellaneous expenses 28. Subtotal Direct Expenses 29. Proration: General & Management Expenses 30. Total Expenses 31. Surplus (Deficit) Total Expenses Expenses Covered By Requested Grant B. If you feel elements of your budget need explaining, please do so in no more than ½ page. 7 Revised GFNY Common Application Form, effective November 2006

GRANTMAKERS FORUM OF NEW YORK COMMON REPORT FORM INFORMATION FOR GRANTMAKERS AND GRANTSEEKERS The Common Report Form (CRF) was developed in 1999 by the Rochester Grantmakers Forum and the Rochester Effectiveness Partnership program to facilitate the reporting process for both grantmakers and grantseekers, and to help them focus on results. Grantmakers and grantseekers worked together to create it. Funders want to know about the actual outcomes of funded projects and what grantees have learned both positive and negative outcomes - not just quantitative data about how many people were served or how many activities took place. Funders investing in our community and grantees delivering services need to understand whether or not particular program services make a difference in the lives of those who receive them. Examining outcomes helps an organization gain valuable information about how to strengthen its work and improve results for those who receive services. Communicating what is learned, including results, also can provide a platform to engage current funders, attract new funders and volunteers to support a program. We recommend that the Common Report Form be completed and sent to funders 12 months after their financial support is received unless they require a different reporting schedule. This latest version of the CRF is a companion piece to the Common Application Form. The Common Report Form is most effective when a logic model is used to develop plans for the funded project or capital purchase, and results are tracked through that logic model. If you have little or no experience developing logic models or determining the impact of your services we refer you to: 1. The Rochester Area Logic Model located on the Grantmakers Forum of New York website (www.grantmakers.org). This information site contains a downloadable logic model, guidelines for developing a logic model, and samples of completed logic models. Also included with the Common Application Form. 2. Rochester Area Logic Model Training is available from St. John Fisher College Center for Community Engagement, Nonprofit Training Program. Both Basic and Advanced level trainings are offered on a regular basis. The Basic Training includes: What a Logic Model is; Uses of a Logic Model; How to Develop a Logic Model. The Advanced Training includes: Indicators for Measurable Outcomes; Evaluation Strategies; Uses of the Logic Model in Management Decisions. Contact Joanne Robinson, Administrator at jrobinson@sjfc.edu to obtain the training schedule. This training is partially funded by local funders which has kept it at an affordable cost. 3. The Program Evaluation Manual developed by the United Way of Greater Rochester. It describes a step-by-step process that you can use, even if you are not a United Way-funded agency, to track the effects of your work. Call Patricia Davis, Director, Operating Practices, United Way of Greater Rochester, 585-242-6561, to request a copy. 1 Revised GFNY Common Report Form, effective November 2006

GRANTMAKERS FORUM OF NEW YORK COMMON REPORT FORM Please answer the following as completely and succinctly as possible. Submit this report 12 months after receiving a grant unless the funder requires a different reporting schedule. SECTION A (Complete Section A directly on this sheet.) Organization completing report: Address: Contact Person: Phone: Project Name: Funder receiving report: Grant Amount: Report Due Date: This report covers the time period of (date) to (date). Type of Support: Capital: construction renovation equipment Endowment Program/Project General support for agency operations Other (describe) Your signature: Your title: Date: SECTION B: FUNDER S NOTES (leave blank for funders to make notes here) 5 Revised GFNY Common Report Form, effective November 2006

SECTION C 1) Use the attached form to compare your original budget with actual figures. Explain any variations from the original budget that are larger than 10%. Answer items 2-5 in up to 2 pages: 2) Has this grant been instrumental in attracting additional support in the form of people, money, goods, services or publicity? If so, describe. 3) Review your logic model (or original plans, if no logic model exists for this effort) and: a. Provide information about each outcome you indicated you would track. b. Describe and explain any significant variances from the original plans outlined in the logic model. 4) Lessons Learned: What have you learned, e.g. about effective program strategies, realistic outcomes, usefulness of the logic model (include any feedback you want us to have about the logic model), on-going value of the project. 5) If applicable, summarize your current plans for the project s future: a. Programming envisioned b. Financial support envisioned c. Your ability to secure necessary support in the future 5 Revised GFNY Common Report Form, effective November 2006

1. FINANCIAL REPORT A. Provide the following information regarding the program or project for which you received funds. SUPPORT/REVENUE 1. Requested grant 2. Fundraising events 3. Gifts/bequests 4. Miscellaneous contributions 5. Foundation/corporate grant support 6. United Way 7. Grants/contracts: govt. agencies 8. Program service fees 9. Membership dues 10. Investment income/transactions 11. Sales: services, products, crafts 12. Miscellaneous revenue 13. Subtotal Direct Support/Revenue 14. General & Management Income (prorated) 15. Total Support/Revenue BUDGETED Total Anticipated Support/Revenue ACTUAL Actual Support/Revenue EXPENSES 16. Salaries of provider staff 17. Fringe benefits 18. Professional fees (contract, consultant) 19. Supplies (consumable) 20. Printing and postage 21. Occupancy 22. Phone and fax 23. Travel and meetings 24. Training 25. Evaluation 26. Equipment purchases 27. Miscellaneous expenses 28. Subtotal Direct Expenses 29. General & Management Expenses (prorated) 30. Total Expenses 31. Surplus (Deficit) BUDGETED Total Anticipated Expenses ACTUAL Total Actual Expenses B. Explain any variances between budgeted and actual figures that are larger than 10%. 5 Revised GFNY Common Report Form, effective November 2006

3. ROCHESTER AREA LOGIC MODEL (See attached Logic Model Section for guidelines and sample logic models.) Program/Project Agency Date Program/Project Time frame: Program/Project Goal: Names & titles of those with key roles in developing logic model: Inputs ($$, staff, volunteers, materials & other resources required) Quantify inputs wherever possible (e.g. 2.5 FTE social workers, 270 volunteer hours ) Activities (What the program does with the inputs to achieve its outcomes) Activities should be quantified (e.g. 2 support groups/10 moms ea./2 hrs/wk for 4 mos.) Projected Outcomes (Effects on knowledge, attitudes, skills, behavior, condition or status during or after the program/project) Shorter-term Outcomes Longer-term Outcomes Place a * next to those to be measured Place a * next to those to be measured (Add additional pages if needed.) 5 Revised GFNY Common Report Form, effective November 2006